Same Day Surgical Intervention Dramatically Minimizes Complication Occurrence and Optimizes Perioperative Outcomes for Central Cord Syndrome

Abstract

Abstract INTRODUCTION As surgery is increasingly recommended for patients with neurologic deterioration secondary to central cord syndrome (CCS), it's important to investigate the relationship between time to surgery and patient outcomes. The merits of early vs delayed surgical treatment remain controversial in the literature. METHODS CCS patients were isolated in NIS database 2005 to 2013. Operative patients were grouped by time to intervention: same day, 1-d delay, 2, 3, 4 to 7, 8 to 14, and >14 d. ANOVA and chi-squared tests compared demographics, Charlson Comorbidity (CCI) scores, length of stay (LOS), discharge status, periop complications, and charges across patient groups. Controlling for age, CCI, and concurrent traumatic fractures, binary logistic regression assessed surgical timing associated with increased odds of periop complication, using same-day as reference group (OR [95% CI]). RESULTS Included: 6734 CSS patients (59 ± 16 yr, 26% F, CCI: 1.2 ± 1.6). Rate of surgical treatment was 64.1%, with rates of surgery increasing from 2005 (50%) to 2013 (73%, P < .001). The most common injury mechanisms were falls (30%) and pedestrian accidents (7%). Of patients that underwent surgery, 52.0% underwent fusion (62% 2-3 levels, 33% 8-levels, 1% 9 + levels), 30% discectomy, and 14% other decompression of the spinal canal. Same-day patients had the lowest LOS, total charges, and the highest rates of home discharge. Same-day patients showed a trend of lower periop sepsis neurologic complications. Patients delayed >14 d to surgery had increased odds of periop cardiac (7.0 [1.6-30.0]) and infection (6.1 [2.2-16.3]) complications. Timing groups beyond 3-d showed increased odds of VTE: 4 to 7 d (3.0 [1.6-5.5]), 8 to 14 d (3.0 [1.4-6.3]), 14 + d (5.6 [2.3-13.6]). CONCLUSION CCS patients undergoing surgery the same day as admission had lower odds of complication, hospital charges, and higher rates of home discharge than patients that experienced a delay to operation. Delay >14 d to surgery was associated with inferior outcomes, like increased odds of cardiac complication and infection.